Thursday, February 14, 2008

NHS stupidity

It is no secret that your humble Devil wants to see the NHS abolished and a private system introduced—albeit modelled on the European systems and not the US. The NHS simply cannot continue as it is; despite a doubling of the money handed to the system, taxpayers have seen little benefit. Indeed, the recent TPA report, Wasting Lives In The NHS [PDF], showed that, despite the increase in funds, health outcomes were still shockingly bad, with 17,000 people a year dying unnecessarily.

This poor management, coupled with the sheer evil of political decisions like that which affected Collette Mills, shows that the NHS is increasingly being run for the benefit of anyone except the patients. For fuck's sake, even the doctors are depressed. Even the politicians who have for so long used the NHS as a political football get little out of it as that ball swiftly becomes a millstone.

I believe that NuLabour have realised this. Unfortunately, they are handling privatisation with all of the competence and aplomb with which they have managed the economy: that is to say, extremely poorly.

I have long railed against PFI—a system that allows the government to keep capital expenditure off its books—which fails because it combines the very worst of the public and private sectors.
The reason that PFI has been such a fucking disaster is very simple: it combines many of the worst bits of both public and private sector behaviour. The advantage of PFI was that the private contractor would take responsibility for cost overruns and, of course, the Chancellor could pretend that he wasn't really spending any cash.

Unfortunately, the responsibility bit didn't take. The government could not let the PFI consortium go bust, e.g. in the case of Mapely Steps, the tax-haven based company that, ironically, bought and runs all of the Customs and Revenue Buildings, who had to return, cap in hand, to be bailed out.

Also, as Wat Tyler has consistently pointed out, the state is a Simple Shopper and is utterly outclassed by private sector negotiators when determining contracts.

And, since that Brown arsehole was so desperate to use PFI, private companies and the public commissioners would effectively collaborate on quotes to ensure that the private quote was cheaper than the public sector comparator. No matter that the PFI quote bore absolutely no fucking relation to the final cost, Brown wants PFI so PFI it is.

So, here you have the inefficient Simple Shopper, almost certainly indulging in the state's legendary tendency to shift the requirements several times during the project and effectively in bed with the companies bidding.

On the other side, we have huge companies, driven to make as much profit as possible, working projects for a client with an effectively bottomless wallet who cannot afford, politically, for the scheme to go wrong or the contractor to go bust or pull out. Further, the terms of these contracts ensure that the contracting company have an effective monopoly on the supply-side and running costs for massive installations for the next 30 years or so; in some cases, the contractor will still own the buildings at the end of that time, so the state will have to negotiate another healthy contract after that.

So we have companies needing to make money and essentially featherbedded from any kind of cost implications, the very thing that would normally drive efficiency in the private sector, and a naive, imcompetant and desperate state aiming to hire the company at any cost. It was always going to be a disaster from the taxpayer's point of view.

Now we see another example (which has been long highlighted by Private Eye) of the state being taken to the cleaners—or, if you prefer, "pissing our money up the wall"—because it cannot negotiate a good deal.
Private clinics carrying out NHS care are not seeing as many patients as they should, but they are still getting paid as their income was guaranteed.

Private treatment centres were set up to do minor surgery and diagnostic tests, in a bid to cut waiting lists.

Figures show that just four of the 25 such clinics created in the first wave of openings are doing enough work.

The government said the clinics would be making up the shortfall in work in the future.

There have been two waves of ISTCs (Independent sector treatment centres) opened since the concept was announced in 2003.

The clinics tend to concentrate on treatment such as knee and hip replacements, hernias and cataract operations.

Some are only doing 50% of the work specified in their contract.

What kind of fucking lunatic would negotiate such a contract? Are they insane?

If you want to keep the NHS state-run and state-funded, then fine; you're a fucking idiot, but no more fucking idiotic that sixty years of previous idiots.

If you want to take it private, then you are sensible (although let's look at all of the systems around the world and see which ones actually work), but this half-arsed compromise is just stupid. We have all of the disadvantages of both the private and public sectors and yet none of the advantages.

Make up your damn minds, you stupid fucks: this dithering is costing both lives and money.


lost_nurse said...

You'll notice that many of us NHS grunts vehemently opposed both PFI and ISTCs. I also remember Alyson Pollock being denounced as an union shrill. El Gordo's off-balance accounting is a fcuking scandal - not least given the shortage of capacity in acute care.

There is a revolving door PFI mafia at DoH (especially from the likes of McKinsey etc) who wouldn't know what to do with a bedpan if it came with instructions - like one of those speaking de-fibs. I despise them more than I know how to say (the people, not the de-fibs).

Henry North London said...

There was a PFI consortium that built the new Highgate Mental Health Centre for £20 million

The building overheats in summer, there isnt airconditioning on the wards and theres no ventilation plus all the offices have paper thin walls

I have a sneaking suspicion that it was built for 10 million and that the consortium made £10 million pounds profit

Mark Wadsworth said...

Totally agreed with all that.

the A&E Charge Nurse said...

Devil - why should the state have ANY role in providing health services, unless you don't trust the fat cats to provide a system that is affordable, universal and equittable - something the NHS aspires to, in principle at least, despite the best efforts of NuLab to sabotage them).

Admit it, you want the state backed insurers because you, (and your libertarian acolytes) realise that the humungous amounts of dosh to be had from cancer, heart disease, HIV, primary care services, etc would soon corrupt even the most enlightened entrepreneur ?

Surely the USA most closely resembles the sort of (relatively) state free model that is farthest from the socialist ideals you claim to loathe ?

chris said...

PFI failed for exactly the same reason that John Major's Internal Market failed, because it refused to let failing hospitals go bust. No rational manager would try to be efficient in those circumstances. Scrimp and save and you just get next years budget cut so that you have to work even harder. Spend like a drunken sailor and the government simply hands over ever larger chunks of our money.

Devil's Kitchen said...


"Devil - why should the state have ANY role in providing health services, unless you don't trust the fat cats to provide a system that is affordable, universal and equittable - something the NHS aspires to, in principle at least, despite the best efforts of NuLab to sabotage them)."

I would happily leave it to the fat cats, actually. However, since everybody would continue to bitch and moan about the poor, one has to attempt to compromise.

Oh, and while we are about it, you told a bit of a whopper on another thread a couple of weeks back: you said that in the US, cancer was an immediate reject for medical insurance.

"American health insurers instinctively reach for the barge pole if you have... cancer (obviously)..."

Then you provided the link: the immediate reject was for cancer currently undergoing treatment.

You can't buy insurance when you already have the damn disease: that is not how insurance works.

In which case, I have absolutely no problem with people, as you put it, "people selling property to pay for life saving treatment ?"

Those ordinary people have obviously decided that their life is more important than their property: it's a choice, you see.

But that isn't even the case much of the time: credit is cheap in the US. My friend took out a large loan to pay for his cancer care. But the point being that he is still alive, and not just sitting, dying, on a waiting list.

But the clue, might be in something else you said in that comment...

"Perhaps, it's because this iniquitous system has proved to be the most costly in the world, yet still fails to offer universal provision ?"

If universal provision is what interests you (and in politics, it has to be at the moment), then one has to look elsewhere.

There are better systems: why adopt a system that is not as good because of pure dogma? That's not principled, it's just stupid.


Roger Thornhill said...

NOTE: short of time brain dump in progress...

We are currently enduring the NHS, Mrs T giving birth via an emergency C-sect.

Many good things, but now, after the section, the midwifery service has been patchy at best and on occasion surly, chaotic, retarded, protocol-driven. Slow.

One or two of the midwives are stars. They seem to get alot done quickly with little fuss. Not quite hen's teeth, but pretty close to it.

The attitude of many is really appalling. They act as if we do not pay for the service, as if it is a reluctant 'charity'. If anyone has a right to be sniffy and have the attitude of reluctant donor, it is US, but all we want is to get basics sorted. This has been a stark reminder of one of my main issues with the NHS- the disconnect between the payer and the paid. Those paid have to treat those who do not pay and also treat those who do pay, but they appear to act as if they only have loyalty to the Third Party Payer, i.e. the Treasury. It is WRONG.

I really went in with an open mind, as our centre is an European centre of excellence where key practices are concerned. Shame it totally lets itself down when people have had their op and are recovering and have erratic, grumpy, forgetful people around.

Some have really really made an incorrect career choice. They are still being paid. What really gets my goat is that the stars are probably paid about the same as the slugs. This is so wrong. If good midwives got paid well, we might see the bad ones let go.

the a&e charge nurse said...

Congratulations, Roger.

From my experience of fatherhood do not be too suprised if YOU end up surly, chaotic and retarded, I know I did (for the first year, anyway).

Devil - 'you can't buy insurance once you already have the damn disease', and selling your house (on top of all the uncertainties of facing a wretched disease like cancer) is a life-style choice, apparently.

I'm interested to see how many of the acolytes are keen sign up to a system that appears to deny access to treatment when you really it, and also requires extensive knowledge of real estate.

No such problems for Roger, who apart attitude found little to complain about ?

Roger Thornhill said...

I'm interested to see how many of the acolytes are keen sign up to a system that appears to deny access to treatment when you really it, and also requires extensive knowledge of real estate.

What do you mean "keen to sign up"? We are press-ganged into one right now!

And you think "attitude" is all I am complaining about?